| Literature DB >> 28352651 |
Marie-Astrid Vernet1, Stéphanie Reynard2,3, Alexandra Fizet2,3, Justine Schaeffer2,3, Delphine Pannetier4, Jeremie Guedj5,6, Max Rives7, Nadia Georges7, Nathalie Garcia-Bonnet7, Aboubacar I Sylla8, Péma Grovogui8, Jean-Yves Kerherve7, Christophe Savio7, Sylvie Savio-Coste7, Marie-Laure de Séverac7, Philippe Zloczewski7, Sandrine Linares7, Souley Harouna9, Bing M'Lebing Abdoul9, Frederic Petitjean9, Nenefing Samake9, Susan Shepherd9, Moumouni Kinda9, Fara Roger Koundouno9, Ludovic Joxe9, Mathieu Mateo2,3, Patrick Lecine10, Audrey Page2,3, Tang Maleki Tchamdja7, Matthieu Schoenhals1, Solenne Barbe9, Bernard Simon11, Tuan Tran-Minh11, Christophe Longuet12, François L'Hériteau13, Sylvain Baize2,3.
Abstract
BACKGROUND. The pathogenesis of Ebola virus (EBOV) disease (EVD) is poorly characterized. The establishment of well-equipped diagnostic laboratories close to Ebola treatment centers (ETCs) has made it possible to obtain relevant virological and biological data during the course of EVD and to assess their association with the clinical course and different outcomes of the disease. METHODS. We were responsible for diagnosing EBOV infection in patients admitted to two ETCs in forested areas of Guinea. The pattern of clinical signs was recorded, and an etiological diagnosis was established by RT-PCR for EBOV infection or a rapid test for malaria and typhoid fever. Biochemical analyses were also performed. RESULTS. We handled samples from 168 patients between November 29, 2014, and January 31, 2015; 97 patients were found to be infected with EBOV, with Plasmodium falciparum coinfection in 18%. Overall mortality for EVD cases was 58%, rising to 86% if P. falciparum was also present. Viral load was higher in fatal cases of EVD than in survivors, and fatal cases were associated with higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT), C-reactive protein (CRP), and IL-6 levels. Furthermore, regardless of outcome, EVD was characterized by higher creatine kinase (CPK), amylase, and creatinine levels than in febrile patients without EVD, with higher blood urea nitrogen (BUN) levels in fatal cases of EVD only. CONCLUSION. These findings suggest that a high viral load at admission is a marker of poor EVD prognosis. In addition, high AST, ALT, CRP, and IL-6 levels are associated with a fatal outcome of EVD. Damage to the liver and other tissues, with massive rhabdomyolysis and, probably, acute pancreatitis, is associated with EVD and correlated with disease severity. Finally, biochemical analyses provide substantial added value at ETCs, making it possible to improve supportive rehydration and symptomatic care for patients. FUNDING. The French Ministry of Foreign Affairs, the Agence Française de Développement, and Institut Pasteur.Entities:
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Year: 2017 PMID： 28352651 PMCID： PMC5358491 DOI： 10.1172/jci.insight.88864
Source DB: PubMed Journal: JCI Insight ISSN： 2379-3708